TWAD: Wellness Brief: Type 1 Diabetes
TWAD: Wellness Brief: Type 1 Diabetes Transcript
Dr. Marcie Drury Brown
Every year we see somebody when the diagnosis is missed, that for whatever reason and no blame to anybody, you know, parents, a lot of times have even taken their child to be seen. And it looks like something else. You know, usually it's 'cause it looks. The flu. But their child is peeing more, even though they've been throwing up and they come in a day or two later, just so ill in the ICU, and so sick and so anything that we can do to increase awareness, to be able to help these families. Cash us this disease earlier so that we can prevent their kids from being as sick when they're diagnosed, I think is just so incredibly valuable.
Jennifer Semenza
Hello everyone and welcome to talk with the. Wellness breeds a podcast offering a quick dose of healthcare information on a wide range of trending topics in under 15 minutes. Today we'll be discussing Type 1 diabetes, which effects around 40,000 new individuals every year. Although it's most often diagnosed in children, teenagers and young adults, it can develop at any age. I'm Jennifer Samenza and here we think today is Doctor Marcie Drury Brown, a pediatric endocrinologist and medical director for the Pediatric Medical specialties Providence, Portland, OR. Well, welcome, Doctor Deary. Thanks so much for joining us today.
Dr. Marcie Drury Brown
Thank you so much, Jennifer, for having me for bringing up this. Important topic.
Jennifer Semenza
A family finds child was recently diagnosed with type 1 diabetes, which came as a real surprise to everyone in the family. So raising awareness on this topic is really important to me to reduce fears, promote early diagnosis and better management and really improving the quality of life for those affected. So for those of. Us that aren't really familiar with type 1 diabetes. What is it and how does it differ from Type 2?
Speaker
Yeah.
Dr. Marcie Drury Brown
Yeah, that's a great. So type 1 diabetes is an autoimmune condition. Where the beta cells of the pancreas that make insulin are no longer able to make insulin, they're destroyed by the immune system. And so for people who have type 1 diabetes, they're not able to make insulin for very limited amounts of it, not enough to be able to maintain. Healthy life. Whereas people with type 2 diabetes typically, at least in the beginning of that disease. They have beta cells that are functioning that are making lots of insulin, but they their body is resistant to insulin and so they need medications that can help their insulin work better for them, make them more sensitive to insulin or help them make even more insulin people with. One diabetes, because they're not able to make insulin, they have to take. And or receive additional insulin in order to be healthy.
Jennifer Semenza
And really, we're gonna be focusing solely on Type 1 today. Are there early signs and symptoms of type 1 diabetes that people should be aware of?
Dr. Marcie Drury Brown
Yes. Although I will say I don't want anybody to feel like they missed something because they can be sneaky, particularly in kids who are so resilient and kind of hide the symptoms. The classic early symptoms for type 1 diabetes are peeing more and drinking more. And that's the most classic symptoms. And so that can look like just needing to go to the. All the time. Maybe a child is getting? Multiple times at night to go to the bathroom. Or there is a child who was, you know, potty trained and able to not have accidents overnight and now is having accidents. But other symptoms can be changes in appetite, weight loss, changes in energy level. Those are all things that are seen early or as a diagnosis is progressing and becoming more apparent.
Jennifer Semenza
And how is type 1 diabetes? Are there tests or typically involved in the during the diagnosis process?
Dr. Marcie Drury Brown
So the way to diagnose type 1 diabetes is a blood sugar test. So the definition of diabetes is to have high blood sugar and the the initial diagnosis is made with a blood sugar test. And that can be added on to within something that's called an A1C, which gives a sense of what the blood sugars have been like over the past three months. And that is by definition also elevated in. In Type 1 diabetes, to really verify the diagnosis of type 1 diabetes. Then a lot of times something called diabetes antibodies are checked and those are the markers that are associated with type 1 diabetes, those autoimmune markers. And those are most of the time positive and somebody with type 1 diabetes. Now I'm going to add 1 caveat for you not to try to make this too big of an answer, but that's how we have traditionally or classically diagnosed type 1 diabetes. And so that's when the disease becomes obvious or is apparent in that the blood sugars are high. And so we can pick that up and they have symptoms. We have found now that you can catch it sometimes earlier before. They actually have those symptoms and that's called stage 1 or stage 2, type 1 diabetes. And so there is a recommendation, through the JDRF or also known now as breakthrough T1D. That everyone be screened for the antibodies for type 1 diabetes so that we can catch people before they have those symptoms in order to be able to either prevent them from progressing or to slow that progression down and to prevent them presenting as late as people are common. Presenting. So that they're not as sick when they first get diagnosed.
Jennifer Semenza
That's great.
Dr. Marcie Drury Brown
Sorry, maybe that answer was long.
Jennifer Semenza
No, that was great, actually. Really good. Information. Thank you. And you had mentioned that Type 1 diabetes is an autoimmune disorder. So what are the known risk? Or are there typical causes of type 1 diabetes?
Dr. Marcie Drury Brown
That's a great question. It's a little bit challenging to answer, but what I will say is that the most common risk factor is a family history. So the incidence of type 1 diabetes is about one in 300, whereas it's one in 20 or about 5%. If you have a family. With Type 1 diabetes, so there are higher rates in those who where there's a family history. However, most people like 85% of people have no family history of Type 1 di. Diabetes in some of those people, there is a family history of another autoimmune condition. But sometimes there's no history of any autoimmunity or anything else. It was just one of those random things that happens. The question about triggers for that autoimmune condition. That's the harder question to answer. We know that there are some viral infections that look like they're prob. But it that's work that's still being done to try to, you know, kind of figure that out more what those triggers are. But a lot of times there's really nothing that somebody could have done to prevent it. And I think that that's. It's not like there's, you know, something that somebody could have ate differently or drank differently or do differently. And it was just one of those things that happen. Get we all get these different viruses are all just very common. Know childhood illnesses, adult illnesses and for whatever reason, for some. At that time you know it triggers a thought and mood condition and we really don't see the effects of it until. Potentially. Two years later, depending on the person.
Jennifer Semenza
Oh. I had no. How do people effectively regulate and manage their blood sugar levels when they're living with type 1 diabetes?
Dr. Marcie Drury Brown
Well, a lot of it is following those. Sugar levels. And so checking blood sugars regularly is super important at this time. Using a continuous glucose monitor, it's absolutely standard of care, and it's something that we start typically within one to two weeks of somebody being diagnosed. Having that blood sugar data. Being able to see it and be able to respond to it is really important and then of course you know giving insulin on a regular basis, typically that's either through shots or through. Pump and so being able to use those ways of working, you know, looking at the blood sugars and giving insulin responding is. How? Do it and.
Jennifer Semenza
What are those target ranges for? Blood sugar levels that individuals with type 1 diabetes should be aiming for and and. Are those numbers actually mean?
Dr. Marcie Drury Brown
It's a great question. The standard there are standards for this, so the standard target range for for somebody with diabetes is 70 to 80. And that's called time and range. 70 to 180. This is something that is a metric on the continuous glucose monitors that are used. And so we can track that. The goal is that 70% of somebody's blood sugars fall between 70 and 180 that time and range. That means that even when people are doing really well 30% up to 30% of their blood sugars will be either. Or below that. The goal is less than 4% of those blood sugars are less than 70, and that less than 5% of those blood sugars are over 200. 50 and when we do that, then we have more time and range and that's going to. How much variability there is in blood sugars as well as its overall help? People have more stable blood sugars that's going to improve the A. C which is going to improve long term care, decrease long term complications and just help them feel better and be healthier.
Jennifer Semenza
We know that diet, nutrition play a big role in managing type 2 diabetes. Is the same true for Type 1 and are there specific dietary recommendations for patients with type 1?
Dr. Marcie Drury Brown
So there's differences there. Diet is clearly important with type 1 diabetes, the kind of carbs that you ingest can have different impacts on your body. But carbs are an important nutrition source, and so they are. Off. So really the most important thing from a dietary standpoint. Is to have a well-rounded diet to have those healthy carbs to have good sources of protein to have some healthy fats, you need all of that. Then being a pediatric endocrinologist. I, you know, have most of my patients are kids and so we want them to be able to grow. And so you need all those factors to be able to grow well and have a healthy child. And so we want them to have just a healthy well round. Diet. So that they can grow well, be healthy kids. Some people choose to do a lower carb diet. And that's a choice that can be. There are some some benefits to that, but it's not something that's required. Really what works best for that child and. Family in their eating style.
Jennifer Semenza
Got it. How important does physical activity for people with this diagnosis and are there types of exercise that are the most beneficial?
Dr. Marcie Drury Brown
Activities are really important it. There's not really anything that's better than another. The best activity is the activity that the person enjoys doing and that they do consistently. So whatever floats their boat.
Jennifer Semenza
That's a really good advice.
Dr. Marcie Drury Brown
Yeah, let them have. Activity is so important for us for so many reasons, but they also it also helps the blood sugars. Decreases overall insulin need and it just helps them to be a healthy person overall and so. It is something to manage in addition. But it's a good thing to need to manage. Helps. It really helps people be healthy and so I. I don't care what activity they're doing, as long as they've got something that they enjoy doing.
Jennifer Semenza
I imagine that's just very much a part of the treatment process.
Dr. Marcie Drury Brown
Yes. And for kids plays activity. And so to go to the park or to go to the backyard and play like. You know. Fun. And that's what it should be.
Jennifer Semenza
Can you discuss with us different types of insulin and insulin delivery methods available to patients with type 1 diabetes?
Dr. Marcie Drury Brown
Yes. So insulin, insulin can be given in a couple of different ways. When you think about giving it a shot, there's two main types of insulin. A long acting insulin and a short acting insulin. Those both need to be given in order to maintain good blood sugar. What we've found for most people is that the best. To do. Management to give insulin is through an insulin pump. That is what I'm going to call a smart. So it's a pump that has an algorithm brains behind it. That allows it to respond to the blood sugar changes that it's communicated to it through the continuous glucose monitor. And so you really want to use a system of a continuous glucose monitor and an insulin pump that talk together so that the pump can respond to the blood sugars. And what we found with that is that across the board, people have. Better time and range. Lower A1CS and I have found that it's easier to manage diabetes with these systems and so it hits the the Holy Grail of type 1 diabetes management in that you get better results with less effort. That is fantastic. That exactly. So I've been doing type of diabetes care for 20 years, which makes me feel old, but I've been doing it for 20 years and really these systems have taken off in the past, you know, 5 to 10 years. Really gotten a lot. Better and I have just found that my patients have better time and range. They have better A1C's and it's not that I've gotten that much better or that they're working that much harder. That the tools we have to help manage this disease have gotten better. And so. Super encouraging and just a really the really exciting time to be in in that type 1 diabetes care management means that we have these better tools that really help.
Jennifer Semenza
Yeah.
Dr. Marcie Drury Brown
So I will tell you that for patients who are newly diagnosed. What I tell them at the very beginning is not a matter of if you use a pump and CGM, it's which one.
Find the combination that works best for you. There is more than one. I don't have a favorite. I want you to find one that works well for you and use it, and then you'll do well.
Jennifer Semenza
That's great advice. Thank you. Really encouraging. We know the Type 1 diabetes is more commonly diagnosed in children and young adults. So how can we better support them, both medically and emotionally as they grow up?
Dr. Marcie Drury Brown
Yeah, that support of course is going to vary over over the years of the child depending on when they were diagnosed. You know, you gave the example of of your family friend with a 2 year old that was diagnosed with. So he's 10 or 15, so you want to you want to make it developmentally appropriate. And so the the care that kids are going to need is going to vary over the years. I think a lot of things part of it is remembering there's still a child. And Type 1 isn't the only thing in their. So when you're having conversations with your team, for example, don't start with what your blood sugar has your diabetes doing. Start with how was your day. How are you doing? You know, do you need help with anything starting with those things that you would that you would ask any other child to have? And if it's if you need to later on bring in, OK, how can I help you? Know is there something going on? But start to ask about. 1st all the time. Don't also always make it about diabetes. That's one thing I hear from the teens is that they get frustrated when maybe they're just having a bad day and it's not diabetes. They're just having a bad day. So don't always make it about diabetes. Them just be kids and teens.
Jennifer Semenza
That's great. That's really, really helpful. They are not a diabetic child. They are a child with diabetes, you know, emphasis on the child first, I imagine.
Dr. Marcie Drury Brown
Exactly, exactly. It's not. Not. Whole life, but know that it is. A chronic. It's something that you have to take care of every day, so there is that element can be that element of burnout and so finding ways that are appropriate ways to check in, being supportive in ways that you, you know, if you talk with. Them about when they're, you know, when they're not upset about something and you know and kind of work those things out and just keeping keeping communication open.
Jennifer Semenza
Yeah, what advice would? Give to parents of children who are newly diagnosed with type 1 diabetes.
Dr. Marcie Drury Brown
1st I would want them to know that their child is still their child, still the same child. They haven't changed their lives and interests. Personality is all there. Still, their child. Secondly, they do not have to be perfect. A lot of families feel overwhelmed and it is very overwhelming at first, but they don't need to be perfect and it's going to get easier as you go forward. How fast it gets easier depends on the family, but it definitely gets easier as you go forward and so they have a wonderful future. This doesn't change their wonderful future. The other thing I would say is that there's peer support. And so they can reach out to their local breakthrough team and chapter, formally known as A. And they have mentor families who are willing to support new families as they are diagnosed and help them through. And so again get support. It's it's hard for the entire. It's a big change for the entire family, but it will get easier and and they can get through it and we will link to those resources in our show notes as well.
Jennifer Semenza
Wonderful. Are there tips you can offer parents to help. Build independence with their child, who might be managing Type 1 diabetes?
Dr. Marcie Drury Brown
Yes. So I think a lot of that is starting small and building from there just because one child can manage their diabetes independently at one age doesn't mean that another child can. Let each person is unique and when they can do that a good time or. A common time of getting some. That independence, that's at school, believe it or not. And so all kids with diabetes have to have a school plan. And most of these plans have them be either be with support from the school or independent. And so one of the ways that kids can start to build independence. Is. Manager their diabetes at school Oregon, doing their lunch insulin on their own without having to go to the. And so you start building some of that in that situation where there's easy accountability, you know that they've got support if needed, that can be a great time. To build up, build up that independence, and then thinking about like smaller time periods. First sleepover? Where did they go? Who's there thinking? How do we support? But how do we also let them build some of that independence? Thinking about again, communication plans? Sleepover goes. Maybe then they can do a weekend with the. Or maybe it's the other way around because the grandparents are really involved and knew a lot about diabetes, and so they can be that support. If you and you know, so thinking about the family, the support they have. And then building on those small occurrences until they have more and more independence. And like with other.
Jennifer Semenza
Other diagnosis is, I imagine, that stress and mental health really impact type 1 diabetes management. What strategies can? Offer that would help address those challenges.
Dr. Marcie Drury Brown
Yeah. So stress on its own is. A kind of. Can be a trigger for high blood sugar. So, but you also think it like there's overall kind of general stress, you know that that can have an impact and. Dental health concerns definitely have impacts on overall control. They studies have shown that kids with diabetes who are depressed or anxious have tend to have higher A1C levels. And so part of is that awareness and looking for those signs. I think part of it is normal. This it's really common for a lot of teams. Diabetes management teams. There's a behavioral health provider on that team. And so in our clinic, we normalize seeing the baby behavioral health provider. Everybody sees them at. Gnosis interval checks whenever you want and justice. Having that be a part of the care and knowing that that's OK and. You're going to go through stressful times and you've got people here who can help you and support you and give you tools that can be really. I also think it can be helpful for the and again I kind of keep leaning more towards the teens because they have that building independence and you see some of this more with them, but it can be helpful for younger kids too. Having a friend with diabetes, it can be helpful to have a peer. You don't need to have all the friends don't have to have diabetes, clearly, but it can be really helpful to have somebody who just gets it, who understands what it's like to have a challenging diabetes day. You know, you do everything right and your blood sugars just Don. Well, still. That you know, that's hard. And so having somebody who can just you can just, you know, screenshot your blood sugar and they just they just get it. Know that can be helpful to have that that peer support and one thing that's been really that's been really helpful for a lot of kids. But a lot of kids. Camp. And so I can't stress the importance of diabetes camp. I've been to diabetes camp in North Carolina and Oregon, where I am now, and these camps are. They allow kids with diabetes to come together, have a very normal camp experience and also build those relationships and peers and I. Lots of. Kids who look forward to this every year and and having that that kind of special time and again, you know, it allows that peer relationship, people who just get it and incorporating diabetes care within a camp. So those are the fabulous way to have that support.
Jennifer Semenza
And I imagine that it takes that isolation aspect out of out of that child's life. For a while. They, you know, all of a sudden, there's there's an entire summer camp filled with kids who have the same diagnosis. How great for them to be able to find that support and encouragement.
Dr. Marcie Drury Brown
Exactly. And you know, it's easier to stay in touch. Kids get each other's cell phone numbers, so it's like again, so then you can text and stuff. I mean, back in our day. Would have been writing pen pal letters but.
Jennifer Semenza
Much easier to text exactly. Well, as we wrap up this episode on Type 1 Diabetes, I hope that the insights shared today really have provided our listeners with valuable knowledge and guidance. Managing Type 1 diabetes can be challenging, but with the right information, support and tools, it is possible to live a healthy and fulfilling. It. Like doctor jury Brown, thank you so much for your expertise and for shedding light on the importance and of effective diabetes manage. Your time here was great today.
Dr. Marcie Drury Brown
Absolutely. Thank you so much. Appreciate it.
Jennifer Semenza
I also want to thank our audience for joining us today on talk with Doctor Wellness brief. We look forward to continuing the important conversation on health and Wellness, with more experts from Providence and sharing our mission of health for a better world. To get continued information on other important healthcare topics, please subscribe to talk with the doc on your favorite podcast platform and on social media. With us on. TikTok and X at Providence and on Instagram and LinkedIn under Providence Health system to learn more about our mission, programs and services go to providence.org. For all of this and more, please download the Providence app on your smartphone and Please remember the information provided during this program is for educational purposes only. Should always consult your healthcare provider if you have any questions regarding a medical condition or treatment. Thanks for listening.
